January 1, 2000Medical Decision Making
Decision Analyses for Prophylactic Replacement of the Björk-Shiley Convexo-concave Heart Valve:
Why the study?
Does prophylactic replacement of the Björk-Shiley convexo-concave heart valve improve life expectancy in patients with implanted valves?
Population
2,263 patients with Björk-Shiley convexo-concave mechanical heart valves implanted between 1979 and 1985 in…
Comparison
Prophylactic replacement of the Björk-Shiley… vs Conservative management
Design
Cohort
Authors
Discussion
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Implication
May advise against prophylactic replacement for most surviving patients; challenges prior constant-hazard decision models.
Key Points
- To re-evaluate modeling assumptions and construct an updated decision-analytic framework for guiding prophylactic replacement of Björk-Shiley convexo-concave heart valves.
- Analyzed follow-up data from 2,263 patients with Björk-Shiley convexo-concave valves implanted in the Netherlands between 1979 and 1985.
- Evaluated 50 outlet strut fractures and 883 non-fracture deaths to model age-dependent fracture hazards and post-implantation life expectancy.
- Fracture risk declined with advancing patient age during follow-up, contrary to the constant hazard assumptions used in previous models.
- Non-fracture mortality data did not support constant additive excess-risk assumptions, showing shorter patient life expectancies than previously estimated.
- The revised model demonstrated that over 90% of surviving patients do not benefit from prophylactic replacement, as fracture risk causes only a minor reduction in remaining life expectancy.
Structured PICO
Does prophylactic replacement of the Björk-Shiley convexo-concave heart valve improve life expectancy in patients with implanted valves?
P
Population
2,263 patients with Björk-Shiley convexo-concave (BScc) mechanical heart valves implanted between 1979 and 1985 in The Netherlands
I
Intervention
Prophylactic replacement of the Björk-Shiley convexo-concave heart valve
C
Comparator
Conservative management (no prophylactic replacement)
O
Outcome
Fracture risks and survival (life expectancy)hard clinical
A revised decision model demonstrates that prophylactic replacement of Björk-Shiley convexo-concave valves is not beneficial for over 90% of surviving patients, as fracture risk decreases with age and has minimal impact on remaining life expectancy.
Cite This Study
Steyerberg et al. (2000) studied this question.